Basic Information
| Provider Information | |||||||||
| NPI: | 1598868069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROY | ||||||||
| FirstName: | ASOK | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAY | ||||||||
| OtherFirstName: | ASOK | ||||||||
| OtherMiddleName: | KUMAR | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 17577 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322457577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043991623 | ||||||||
| FaxNumber: | 9043991624 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322073814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043991623 | ||||||||
| FaxNumber: | 9043991624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31786 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | 31786 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207RC0000X | 31786 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RG0100X | 31786 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0300X | 31786 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | ME99452 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002831500 | 05 | FL | MEDICAID |